| Thrive Family Services Llc | |
|
347 Windy Pine Dr Lake Wylie SC 29710-8120 | |
| (704) 516-2394 | |
| (704) 919-5079 |
| Full Name | Thrive Family Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 347 Windy Pine Dr, Lake Wylie, South Carolina |
| Authorized Official Name and Position | Beth C Wilson (OWNER) |
| Authorized Official Contact | 7045162394 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thrive Family Services Llc 347 Windy Pine Dr Lake Wylie SC 29710-8120 Ph: (704) 516-2394 | Thrive Family Services Llc 347 Windy Pine Dr Lake Wylie SC 29710-8120 Ph: (704) 516-2394 |
| NPI Number | 1528583879 |
|---|---|
| Provider Enumeration Date | 08/08/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 9830434257 |
|---|---|
| Medicare Enrollment ID | O20181212003445 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528583879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Dustin Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083930663 PECOS PAC ID: 7113827015 Enrollment ID: I20161027002073 |
| Provider Name | William S Simons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710993456 PECOS PAC ID: 1355504317 Enrollment ID: I20181212003648 |
| Provider Name | Eliezer Vazquez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114077195 PECOS PAC ID: 0840335675 Enrollment ID: I20210324001895 |
| Provider Name | Jaime L Moffett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780978569 PECOS PAC ID: 5294142808 Enrollment ID: I20210326002027 |
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